Healthcare Provider Details

I. General information

NPI: 1346208022
Provider Name (Legal Business Name): LORIE STORMO MEDICAL TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40520 CO HWY 34 WHITE EARTH HEALTH CENTER
OGEMA MN
56569
US

IV. Provider business mailing address

603 BROADWAY AVE
DETROIT LAKES MN
56501
US

V. Phone/Fax

Practice location:
  • Phone: 218-983-4300
  • Fax: 218-983-6217
Mailing address:
  • Phone: 218-847-6436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246R00000X
TaxonomyPathology Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: